Assess and evaluate HealthChoice
Assess and evaluate HealthChoice, MD’s statewide mandatory managed care program
Overview:
Assume you are a Maryland resident and Medicaid recipient looking to enroll in a managed care plan, review the Maryland Managed Care Website(s) at: https://mmcp.health.
https://mmcp.health.maryland.
Assess and evaluate HealthChoice, Maryland’s statewide mandatory managed care program based on the following evaluation criteria. Please choose one (1) of the MCO’s under HealthChoice to evaluate.
Using the table format below, answer the questions (using a narrative format) in each section that appear in bold type. Please be sure to include a reference page. APA format required.
| HGMT 420 Assignment #5 | |
| Student Name: | Type your name here |
| Assignment #5 Title | HealthChoice/Maryland Managed Care Plan |
| Benefits Offered and Services Covered | You want a plan that offers a comprehensive benefits package including preventive care as well as treatment programs for chronic disease management. Also, you may need emergency care and/or care away from home. What questions would you ask to determine the benefits and covered services offered? Evaluate the HealthChoice plan and summarize your findings. |
| Cost vs. Benefits | Managed care plans vary widely in the cost of services offered. It may be tempting to base your selection primarily on the periodic, out-of-pocket costs to you. You can’t be sure that the least expensive plan will give you all the medical services you need. Review cost vs. benefits for the HealthChoice plan carefully and summarize your findings. |
| Services of the Primary Care Physician | Choosing your primary care physician (PCP) may be the most important decision you make when enrolling in a managed care plan. The following questions are important when choosing your plan: Please answer each question.
How does HealthChoice measure up? |
| Prescription Drug Benefits | When evaluating a health plan it is very important to know what kind of prescription drug benefits the plan offers. Depending upon the plan, there are several systems that have been implemented in efforts to control costs. Some plans offer a “generic only” plan. What prescription drug benefits does HealthChoice offer? Are they beneficial to your current drug regimen? |
| Provider Network and Geographic Service Area | Be sure you inquire from the Provider Membership Directory which providers are included in the network and where they are located in your community. If you live in one community and work in another; determine if routine care can be received in either location. Does HealthChoice have a strong network of Providers in a geographic area that is amenable to you? Must you go to different locations for different services? If you have a child away at school, does the network extend to that area? |
| Commitment to Quality of Care and Service | What measures of quality care and satisfaction of service are available? It is worthwhile to find out if the plan has been accredited by the National Committee for Quality Assurance (NCQA). NCQA is the most common accrediting body for network plans. Review and report on what measures of quality care and satisfaction are available for HealthChoice. |
| Customer Satisfaction | How do enrolled members feel about the plan? There are various objective forms of measurement used to determine “quality services” given by managed care plans such as accreditation, HMO report cards and/or publications produced by the industry. You would be wise to look at any that measure customer satisfaction. The National Committee for Quality Assurance (NCQA) mission is to provide information that enables purchasers and consumers of managed health care to compare plans based on quality. Their web site may be reached at http://www.ncqa.org/ |
| Limitations, Maximums, or Exclusions | Lifetime Cap refers to the maximum dollar amount of benefits available to a consumer in a managed care plan during his or her lifetime. This amount becomes important when confronted with a life-threatening disease or accident that requires prolonged care involving expensive therapeutic intervention and support. Does HealthChoice outline limitations, maximums, or exclusions? |
Solution Preview
Managed Care in Maryland
Benefits Offered and Services Covered
According to the Maryland Department of Health Services, people who qualify for Medicaid are just as likely to qualify for HealthChoice. The Service ensures that patients have access to the necessary care within a managed care organization based on their healthcare needs. Consequently, once an individual makes the application, he or she is given the opportunity to choose a personal care provider or could seek advice from the care provider on which managed care organization to enroll. Since most chronic disease management efforts require a particular healthcare provider with enough knowledge of the patient’s condition, it would be best to seek advice from the personal care provider on the most ideal MCO and consequently proceed to enroll with HealthChoice.
(890 words)